Vital Statistics Form

Please fill this form out as much as possible. It will help us to complete the death certificate and in writing the obituary. All fields with an asterisk are required.

Deceased's Information

If residence, please include address
mm/dd/yyyy
English, Irish, French, German, etc.
Be specific
Primary occupation during working years. *Do not enter \"retired\".
Sales, Medical, Engineering, Construction, etc.
Please list survivors and relationship: son, daughter, brother, sister, etc.
Religious affiliations, fraternal and civic organizations, hobbies, etc.

Informant's Information

A copy of what is submitted will be sent to this email.
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Obituaries & Condolences

Jerry Wayne Waddell, Sr.

Paul James Andrews

Lois Sue Mirkin

Robert Allen Young

Robert “Bob” G. Fuhrman

Harold Kenneth Koehn

Bruce Bernard Frazier II

George Burton Waddle

Robert L. Fritz

Jody Dubois

Robert W. Burrows

Michael Patrick Angell